冠状动脉旁路移植术后使用重组活化凝血因子Ⅶ近中期疗效分析  

Early and mid-term effects of recombinant activated factor Ⅶ for blood loss after coronary artery bypass grafting

作　　者：李东[1] 肖苍松[1] 任崇雷[1] 吴扬[1] 王嵘[1] Li Dong;Xiao Cangsong;Ren Chonglei;Wu Yang;Wang Rong(Department of Cardiovascular Surgery,General Hospital of PLA,Beijing,100853,China)

机构地区：[1]中国人民解放军总医院心血管外科,北京100853

出　　处：《中国体外循环杂志》2018年第6期361-365,共5页Chinese Journal of Extracorporeal Circulation

基　　金："十二五"科技支撑课题(2011BAI11B18)

摘　　要：目的回顾性分析本科近年使用重组活化凝血因子Ⅶ(r FⅦa)进行止血的冠状动脉旁路移植术(CABG)患者,总结r FⅦa在术后使用的临床效果。方法选择2010年7月至2017年7月,本科行CABG术后应用r FⅦa共22例患者,其中20例采用体外循环下CABG,2例采用非体外循环下CABG。CABG同期行主动脉瓣置换术7例(生物瓣6例,机械瓣1例),同期行二尖瓣置换术1例(机械瓣)。给予r FⅦa(初始剂量以35～70μg/kg),记录术前、术中、术后及随访临床资料并进行统计分析,桥血管通畅情况采用64排螺旋CT评价。结果本组患者无二次开胸,应用r FⅦa后第一个小时引流量与应用前一小时引流量相比明显减少,有显著性差异(P <0.05),止血效果良好。随访0.5～7年,平均随访时间(2.98±2.36)年,随访率100%。随访期间总的桥血管通畅率为94.45%,其中动脉桥通畅率94.11%,静脉桥通畅率96.30%。随访期间无死亡,术后血压、血糖、血脂控制良好,术后未出现明显出血情况;随访期间无新发主要不良心血管事件(MACE)。结论 r FⅦa在CABG后渗血的应用中显示出良好的止血效果和安全性。在一定剂量范围内使用r FⅦa,不影响术后近中期桥血管通畅率,不增加血栓形成及MACE的风险。Objective To describe clinical experience with recombinant activated factor Ⅶ (rFⅦa) in management of bleeding after coronary artery bypass grafting (CABG) in our department in recent years.Methods From July 2010 to July 2017,22 cases undergoing CABG used rFⅦa during or after the surgery because of bleeding. Twenty cases received CABG with cardiopulmonary bypass,2 cases received CABG under off-pump.Simultaneous aortic valve replacement was performed in 7 cases (6 cases of biological valve,1 case of mechanical valve) and mitral valve replacement was performed in 1 case (mechanical valve).rFⅦa was administered as an initial dose of 35-70 μg / kg.The data of those patients during preoperative,intraoperative and postoperative periods were reviewed for statistical analysis.The graft patency was evaluated by 64-multi-slice spiral computed angiography ( 64-MSCTA).Results There was no patient reoperated in this group. There was significant difference in drainage volume on one hour before and after the rF Ⅶa administration (P<0.05).The average follow-up time was 2.98±2.36 years and the follow-up rate was 100%. During the follow-up,the total graft patency rate was 94.45%,and the LIMA graft patency rate was 94.11%,and the vein graft patency rate was 96. 30%.The blood pressure,blood glucose and blood lipid were well controlled.No mortality or significant bleeding occurred during the follow-up period.No major adverse cardiovascular events ( MACE) occurred during the follow-up period.Conclusion rFⅦa shows good hemostatic effect and safety in bleeding after coronary artery bypass grafting. rFⅦa can be used in a certain dose range to obtain satisfactory postoperative patency rates in the early and mid-term period postoperatively,without increasing the risk of thrombosis or MACE.

关 键 词：冠状动脉旁路移植术 重组活化凝血因子Ⅶ 桥通畅率 多层螺旋CT 

分 类 号：R654.2[医药卫生—外科学]